Life Course Epidemiology on the Determinants of Stunting in Children Under Five in East Lombok, West Nusa Tenggara
Abstract
Background: Stunting remains a challenging global health issue. It is estimated by Global Nutrition Report that 155 million children were stunted in 2017. Stunting is associated with an underdeveloped brain, with long-lasting harmful consequences, including diminished mental ability and learning capacity, poor school performance in childhood, reduced earnings and increased risks of nutrition-related chronic diseases, such as diabetes, hypertension, and obesity in future. This study aimed to examine the determinants of stunting in children under five in East Lombok, West Nusa Tenggara.
Subjects and Method: This was an analytic observational study with a case control design. The study was carried out in 31 posyandus (integrated family health posts) in East Lombok, West Nusa Tenggara, from April to May 2018.A sample of 186 children was selected by fixed disease sampling. The dependent variable was stunting. The independent variables were low birthweight (LBW), birth length, exclusive breastfeeding, history of infection disease, maternal age at pregnancy, maternal middle upper arm circumference (MUAC), and family income. The data were collected by questionnaire and analyzed by a multilevel logistic regression run in Stata 13.
Results: The risk of stunting increased with LBW (b= 3.51; 95% CI= -0.28 to 7.31; p= 0.069), maternal age at pregnancy <20 or ?35 years (b= 2.73; 95% CI= 0.38 to 5.42; p=0.047), andhistory of infectious disease (b= 3.70; 95% CI= 0.84 to 6.56; p=0.011). The risk of stunting reduced with high family income (b= -2.15; 95% CI= -4.37 to 0.61; p=0.057), birth length (b= -4.17; 95% CI= -7.42 to -0.91; p=0.012), exclusive breastfeeding (b= -3.24; 95% CI= -5.63to -0.85; p=0.008), and maternal MUAC ?23.5cm (b= -4.53; 95% CI= -8.09to -0.97; p=0.013). Posyandu had a contextual effect on the incidence of child stunting with ICC= 15.00%.
Conclusion: The risk of stunting increases with LBW, maternal age at pregnancy <20 or ?35 years, and history of infectious disease. The risk of stunting reduces with high family income, birth length, exclusive breastfeeding, and maternal MUAC. Posyandu has a contextual effect on the incidence of child stunting.
Keywords: Stunting, low birthweight, birth length, exclusive breastfeeding
Correspondence:
References
Acevedo P, Esteban MTG, Ejeda NL, Gomez A, Marrodan MD (2017). Influence of malnutrition upon allcause mortality among children in Swaziland. Endocrinolog
Akombi BJ, Agho KE, Merom D, Hall JJ, Renzaho AMN (2017). Multilevel Analysis of Factors Associated with Wasting and Underweight among Children UnderFive Years in Nigeria. Nutrients. 9(1): doi: 10.3390/nu9010044.
Akombi BJ, Agho KE, Hall JJ, Merom D, AstellBurt T, Renzaho AMN (2017). Stunting and Severe Stunting among Children Under5 Years in Nigeria: A Multilevel Analysis. BMC Pediatrics. 17(1).doi: 10.1186/s128870160770z.
Ayuningrum IY, Salimo H, Dewi YLR (2017). Path Analysis on Gestational Socioeconomic Determinants of Nutritional Status in Children Under Five in Purworejo Regency Central Java. Journal of Maternal and Child Health. 2(1): 30
Batiro B, Demissie T, Halala Y, Anjulo AA (2017). Determinants of Stunting Among Children Aged 6-59 Months at Kindo Didaye woreda , Wolaita Zone , Southern Ethiopia: Unmatched case control study. PloS ONE. 12(12). https://doi.org/10.1371/journal.pone.0189106.
Chirande L, Charwe D, Mbwana H, Victor R, Sabas K, Issaka AI, Baines SK, Dibley MJ, Agho KE (2015). Determinants of Stunting and Severe Stunting among UnderFives in Tanzania: Evidence from the 2010 Cross-Sectional Household Survey. BMC Pediatrics. Vol. 15, No. 165. doi: 10.1186/s1288701504829.
De Onis M, Branca F (2016). Childhood Stunting: A Global Perspective. Maternal and Child Nutrition. 12(1): 12
Derso T, Tariku A, Biks GA, Wassie MM (2017). Stunting, wasting and associated factors among children aged 6
Indria GA, Murti B, Dewi YLR (2016). Path Analysis: Effect of Gestational Factors, Psychosocial Factors and Antenatal Class Program on Toddler Growth. 1(1): 53-61. https://doi.org/10.26911/thejmch.2016.01.01.08.
Islam MM, Sanin KI, Mahfuz M, Ahmed AMS, Mondal D, Haque R, Ahmed T (2018). Risk factors of Stunting among Children Living in an Urban Slum of Bangladesh: Findings of a Prospective Cohort Study. BMC Public Health. 18(197). doi: 10.1186/s128890185101x.
Kismul H, Acharya P, Mapatano MA, Hatloy A (2018). Determinants of Childhood Stunting in the Democratic Republic of Congo: Further Analysis of Demographic and Health Survey 2013
Mohammed S, Asfaw ZG (2018). Bayesian Gaussian Regression Analysis of Malnutrition for Children Under Five Years of Age in Ethiopia. Archives of Public Health. 76(21). https://doi.org/10.1186/s1369001802646.
Nazri C, Yamazaki C, Kameo S, Herawati DMD, Sekawarna N, Raksanagara A, Koyama H (2016). Factors Influencing Mother's Participation in Posyandu for Improving Nutritional Status of Children UnderFive in Aceh Utara District, Aceh province, Indonesia. BMC Public Health. 16(69). doi: 10.1186/s1288901627327.
Nkurunziza SN, Meessen B, Geertruyden JPV, Corachais C (2017). Determinants of stunting and severe stunting among Burundian children aged 6-23 months: evidence from a national crosssectional household survey. BMC Pediatrics. 17(1): https://doi.org/10.1186/s12887-017-0929-2.
Perkins JM, Kim R, Krishna A, McGovern M, Aguayo VM, Subramanian SV (2017). Understanding the association between stunting and child development in low and middle income countries: Next steps for research and intervention. Social Science & Medicine. 193: 101-109. https://doi.org/10.1016/j.socscimed.2017.09.039
Pusat data dan Informasi Kementerian Kesehatan Republik Indonesia (2016). Situasi Balita Pendek. Jakarta: Pusat Data dan Informasi Kementerian Kesehatan RI.
Rabaoarisoa CR, Rakotoarison R, Rakotonirainy NH, Mangahasimbola RT, Randrianarisoa AB, Jambou R, ViganWomas I, et al. (2017). The Importance of Public Health, Poverty Reduction Programs and Women
Rahayu RM, Pamungkasari EP, Wekadigunawan CSP (2018). The Biopsychosocial Determinants of Stunting and Wasting in Children Aged 12-48 Months. Journal of Maternal and Child Health. 3(2): 105
Rahmadi A (2016). Hubungan Berat Badan dan Panjang Badan Lahir dengan Kejadian Stunting Anak 12-59 Bulan di Provinsi Lampung. Jurnal Keperawatan. 12(2): 209
Sanin KI, Islam MM, Mahfuz M, Ahmed AMS, Mondal D, Haque R, Ahmed T (2018). Micronutrient Adequacy is Poor, but Not Associated with Stunting Between 12-24 Months of Age: A Cohort Study Findings from a Slum Area of Bangladesh. PLoS ONE. 13(3). https://doi.org/10.1371/journal.pone.0195072.
Tariku A, Biks GA, Derso T, Wassie MM, Abebe SM (2017). Stunting and its determinant factors among children aged 6
Tim Nasional Percepatan Penanggulangan Kemiskinan (2017). 100 Kabupaten/ Kota Prioritas untuk Intervensi Anak Kerdil (Stunting). Jakarta: Tim Nasional Percepatan Penanggulangan Kemiskinan.
United Nations (2015). Transforming our World: The 2030 Agenda for Sustainable Development. https://sustainabledevelopment.un.org/content/documents/21252030%20Agenda%20for%20Sustainable%20Development%20web.pdf.
Viridula EY, Murti B, Suryani N (2016). Path Analysis on the Effect of Biopsychosocial and Economic Factors during Gestational Period on the Risk of Stunting and Development in Children under Five, in Nganjuk, East Java. 1: 180
World Health Organization (2015). From MDGS to SDGs: General Introduction. http://www.who.int/gho/publications/mdgssdgs/MDGsSDGs2015_chapter1.pdf.
_____ (2014). WHA Global Nutrition Targets 2025: Stunting Policy Brief. http://www.who.int/nutrition/topics/globaltargets_stunting_policybrief.pdf.
